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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200218
Report Date: 09/28/2023
Date Signed: 09/28/2023 02:52:35 PM

Document Has Been Signed on 09/28/2023 02:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:MISSION-HOPE DAY PROGRAM, DUBLINFACILITY NUMBER:
019200218
ADMINISTRATOR:JAY FRANCIS Y. GAMEZFACILITY TYPE:
775
ADDRESS:6300 VILLAGE PARKWAYTELEPHONE:
(925) 560-9582
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 45CENSUS: 69DATE:
09/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maribeth Wilson; Program DirectorTIME COMPLETED:
03:05 PM
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On 9/28/23 at 10:30 AM, Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced required 1-year inspection. LPA met with Program Director Maribeth Wilson and explained the reason for visit.

LPA toured the facility inside and out including but not limited to facility main room, snack area, restrooms, activity room, reflection room, and computer rooms. Hot water temperature in bathroom area measured at 107.6 degrees Fahrenheit. All toxic and dangerous items are kept locked and inaccessible to clients. Facility has a designated room for individuals if they become ill. Facility has 19 staff members and 5 administrative employees on duty.

Clients have a variety of activities and are provided activity materials. Kitchen and food preparation area were observed as clean.

Smoke and carbon monoxide detectors were observed as operational. Fire drill was last conducted on 10/13/2022. Fire extinguisher was observed as full. First Aid kit was observed as complete. Facility provides their own transportation vehicles. Facility has sufficient supply of snacks and a designated locked cabinet for medications storage.

During record review, LPA reviewed a sample of 5 staff records and observed 5 of 5 have health screening with TB, and first aids certificate on files. LPA sample 5of 5 client records and observed 5 of 5 clients have their IPP up to date.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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